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General NPI Number Information
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NPI Number | 1245099696
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Entity Type | Individual
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Provider Name | DOMINIC THOMAS LANE
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Gender | Male
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1408 NW 6TH ST FL 32601
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City | GAINESVILLE
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State | FL
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Zip | 32601-4020
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Country | US
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Telephone | 352-373-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 91 FOSTER LN
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City | PALM COAST
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State | FL
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Zip | 32137-4411
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Country | US
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Telephone | 386-334-0094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-324980
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License Number State | FL
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